Provider Demographics
NPI:1083898845
Name:STATEN ISLAND AID FOR RETARDED CHILDREN, INC
Entity Type:Organization
Organization Name:STATEN ISLAND AID FOR RETARDED CHILDREN, INC
Other - Org Name:COMMUNITY RESOURCES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MAGEE
Authorized Official - Suffix:
Authorized Official - Credentials:CEO/EXECUTIVE DIRECT
Authorized Official - Phone:718-447-5200
Mailing Address - Street 1:3450 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6721
Mailing Address - Country:US
Mailing Address - Phone:718-447-5200
Mailing Address - Fax:718-448-6939
Practice Address - Street 1:3450 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-6721
Practice Address - Country:US
Practice Address - Phone:718-447-5200
Practice Address - Fax:718-448-6939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6669300251C00000X
NY28330320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02625152Medicaid
NY02003625Medicaid
NY02704525Medicaid
NY01489752Medicaid
NY02169524Medicaid
NY02249741Medicaid
NY02592565Medicaid
NY02740696Medicaid
NY00357584Medicaid
NY02249732Medicaid